Abstract [en]

Background: Globally, socially and economically disadvantaged populations have been shown to suffer more oral health problems. The same trend can be seen in oral health service utilization. A few studies on inequalities in oral healthcare coverage have been conducted in HICs, however evidence in LMICs is limited.

Aim: The aim of this study is to assess and compare socio-economic inequalities in oral health services coverage among older adults in China, Ghana and India.

Methods: This study is a secondary analysis of data collected by the WHO Study on AGEing and adult health (SAGE). The SAGE Wave One data among adults 50 years and over in China (N=1,591), Ghana (N=425) and India (1,307) were analysed. The dependent variable is ‘no-coverage’ defined as the proportion of individuals with expressed need of oral healthcare services who did not receive treatment. Various methods are used to measure absolute and relative inequalities such as risk ratios, the slope index of inequality, the relative index of inequality and the concentration index. The measures are adjusted for age, sex, area of residence, marital status, work status and overall health status.

Results: The prevalence of no-coverage was more than 60 percent in all countries with highest proportion in Ghana (80). Inequality in no-coverage was observed in all three countries. The least educated and the poorest adults showed greater relative and absolute inequalities.Wealth-related inequality in no-coverage is disproportionately concentrated among the poor with largest value in Ghana (-0.24). Determinants that contributed the most inequalities were - area residents, education and wealth in China; education, wealth and work status in Ghana; education and marital status in India.

Conclusion: Socio-economic inequalities in oral health service coverage is an important measure of progress in oral health and overall population health. The findings of our study may inform service providing authorities to develop equitable policies for oral health in favour of socially disadvantaged older adults in LMICs.